A Cochrane review [Abstract] 1 included 24 studies with a total of 2996 subjects with post-dural puncture headache (PDPH). Eighteen trials (n=2477) compared either bed rest vs. immediate mobilization or a longer vs. a shorter period of bed rest. Six of these trials (n=723) involved people undergoing diagnostic lumbar puncture; 4 trials (n=381) people undergoing spinal anaesthesia for surgical procedures, 7 trials (n=1165) people undergoing myelography and one trial (n=208) people undergoing lumbar puncture for any reason. Three trials (n=106) evaluated the effects of a head-tilt versus no head-tilt in addition to bed rest and two trials (n=200) the effects of supplementary fluids during either diagnostic lumbar puncture or myelography. There was no evidence of benefits associated with bed rest vs. immediate mobilization on the incidence of severe PDPH (RR 0.98; 95% CI 0.68 to 1.41; 9 studies, n = 1568), or any headache after lumbar puncture (RR 1.16; 95% CI 1.02 to 1.32; 18 studies, n = 2477). Furthermore, bed rest probably increased PDPH (RR 1.24; 95% CI 1.04 to 1.48; 12 studies, n = 1519) compared with immediate mobilization. An analysis restricted to the most methodologically rigorous trials (i.e. those with low risk of bias in allocation method, missing data and blinding of outcome assessment) gave similar results. There was no evidence of benefits associated with fluid supplementation on the incidence of severe PDPH (RR 0.67; 95% CI 0.26 to 1.73; 1 study, n = 100) and PDPH (RR 1; 95% CI 0.59 to 1.69; 1 study, n = 100), or on the incidence of any headache after lumbar puncture (RR 0.94; 95% CI 0.66 to 1.34; 2 studies, n = 200).
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